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Arch Phys Med Rehabil. 2014 Apr;95(4):770-83. doi: 10.1016/j.apmr.2013.11.015. Epub 2013 Dec 12.

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle.

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  • 1Department of Clinical Therapies, University of Limerick, Limerick, Ireland. Electronic address:
  • 2Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
  • 3Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.



To identify the most effective components in an active exercise physiotherapy treatment intervention for chronic neck pain based on the frequency, intensity, time, and type (FITT) exercise method of tailoring physical activity recommendations to the individual needs and goals of patients.


Databases, including the Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, SPORTDiscus, Biomedical Reference Collection, and Academic Search Premier, were searched for relevant articles.


Quantitative design studies that included active exercise as part of a multimodal or stand-alone approach were selected. Only studies scoring ≥6 on the Physiotherapy Evidence Database Scale were included in the review because this reflected a good level of evidence.


Study methodologies and relevant outcome measures, including isometric strength, Neck Disability Index scores, and pain scores, were extracted from relevant articles and grouped together for appraisal and synthesis.


Evidence from selected articles was synthesized according to the FITT exercise principal to determine the most effective exercise type, frequency, and intensity in the treatment of chronic neck pain.


Physiotherapy interventions using a multimodal approach appear to produce more beneficial outcomes in terms of increased strength, improved function, and health-related quality of life and reduced pain scores. Active strengthening exercises appear to be beneficial for all of these outcomes; the inclusion of additional stretching and aerobic exercise components appear to enhance the benefits of an exercise intervention.

Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.


Exercise; Neck pain; Physical therapy modalities; Rehabilitation

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